Obamacare & Gov. Scott Walker: The Moral & Fiscal Calculus

Wisconsin now holds the rather dubious distinction of leading the nation in the number of low-income people it’s kicking off its Medicaid rolls.

By Emily MillsJournal Sentinel (10/11/13)

Only a short while has passed since the Affordable Care Act’s health insurance exchanges went into effect. Looking out my window, I see no smoldering ruins of a once-great civilization. I see trees turning red and golden and children at recess on a playground. It seems the dire warnings about the alleged ill effects of “Obamacare” have been greatly exaggerated.

So let’s pull off our partisan lenses to take a hard look at the situation. Americans, when they understand what’s actually in it, largely support the ACA. They re-elected the president who pushed to get it enacted. The Supreme Court has upheld the law as constitutional. Vote after vote attempting to repeal it in Congress has failed. And yet legislative Republicans insisted on holding the government hostage over the law.

I support the ACA, and I also recognize that it is far from perfect. It’s a Band-Aid. To be sure, it’s the boldest Band-Aid we’ve yet to apply as a nation to the gaping wound of our health care system. Still, the current rancor of the debate prevents us from really dealing with the bigger problem, which is that we have a system riddled with inconsistency, confusion and straight-up waste.

While we bicker over ideological differences, real people are really suffering.

How can we, as Americans, call ourselves a developed nation when millions of our citizens still can’t afford even basic levels of care? The current model of for-profit health insurance automatically spells disaster for too many people, and not even just those in the lowest income brackets. For instance, my family was once bankrupted by medical bills even though we had a fairly standard insurance plan and a solid middle-class life. The edge is scarily close for most folks, and it’s growing closer all the time.

And we’re stuck dealing with leaders such as Gov. Scott Walker (R-Presidential hopeful), who opted to turn down about $4.4 billion (through 2020) in federal funds for a Medicaid expansion, deciding instead to go for a hybrid approach that tightened income requirements for the state-run system and left everyone else to the private exchange market. That means that a family of four with a yearly income of just $23,550 is no longer eligible for low-to-no cost coverage under state programs. They will instead need to buy insurance on the exchanges and hope that the associated federal subsidies will be enough to make them affordable.

I’m trying to imagine supporting a family of four on so little money, let alone factoring in health insurance costs. It’s difficult enough for an individual making that much money to support themselves, let alone three other people. Contrary to what certain big fast food chains seem to think, simply not paying your heat bill isn’t really an option.

So what do you do?

Wisconsin now holds the rather dubious distinction of leading the nation in the number of low-income people it’s kicking off its Medicaid rolls.

This isn’t just a moral issue, though I’d argue that is the most important consideration. The seemingly visceral hatred by some on the right for anything involving a government role in health care doesn’t make fiscal sense, either.

Walker’s decision to turn down federal funding of a Medicaid expansion will cost state taxpayers about $119 million in 2013-2015 alone, according to a Legislative Fiscal Bureau audit. Meanwhile, the fiscal bureau also reported that many people eligible for coverage through the exchanges —but now ineligible for Medicaid/BadgerCare under the new state plan — will decide they can’t afford it. Why? Because even with federal subsidies they’re being asked to go from having the state cover their health insurance to being made to pay up to up to several thousand dollars a year for the Silver Plan under the exchanges.

For a family making just over 100% of the federal poverty level, that’s money that would otherwise go toward basic necessities such as rent and food. This isn’t a choice we should be forcing people to make.

Republicans tacitly acknowledge the doughnut hole problem by voting to pay hospitals up to $73.5 million over two years to care for uninsured patients. Emergency room treatment is incredibly expensive, especially when it comes to treating things that could easily be prevented if the person simply had access to affordable care in the first place.

But we don’t have a system based on prevention, fiscal responsibility or compassion. We have a big Band-Aid, seeping around the edges and threatening to burst at any moment. It’s time for us to put aside the partisan gamesmanship in order to really deal with the problem. It’s literally a matter of life and death.

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